ACH Cancellation Form Name(Required) First Last Date(Required) Month Day Year Address(Required) Street Address Utility Customer Account Number(Required)Notice of ACH Cancellation(Required) I withdraw consent for the City of Wood Village to automatically debit my bank account.I currently have my payment for the above account number automatically withdrawn from my bank account. Effective immediately, I would like to cancel these automatic withdrawals and submit this form as my written notification of my termination of the automatic withdrawals for the City of Wood Village to debit my account.Signature(Required)By submitting this form, you are signing this Notice of ACH Cancellation form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this notice.Would you like an emailed copy of your submitted Notice of ACH Cancellation form?(Required) Yes, please. No, thank you. Email(Required) Enter Email Confirm Email
